An Introduction Of All the Tools Created for Pillar 4

An Introduction Of All the Tools Created for Pillar 4
This resource is designed to provide a detailed account of all the different tools you will come across as you explore the Physical and Mental Well-Being Pillar of the OACCUs project.
1. Psychoeducation
Aim: Collecting information (Grace et al., 2019; National Cancer Institute, 2023)
1. Key points for collecting reliable information.
2. Indicative questions you can ask the health care professional. 
3. Community cancer centers active in the country. 
4. Worksheets: Assertive Communication (see Annex 1, p. 6),  Decision-Making (Li et al., 2017). 
Implementation: Psychoeducation is the initial step of the toolbox, where the reader will come into first contact with theoretical but concrete material about health literacy, practical questions, and information about cancer centers in their area. At the same time, there are worksheets, e.g. in Pdf format, where the reader can download and complete them.

Wellbeing & Emotional Distress:
- Introduction about the emotional rollercoaster of cancer & cancer survivorship, including depression anxiety, anger, stress, fear of cancer recurrence (Merckaert et al., 2023) (see Annex 3, p. 8): reference to the relevant section of the ambassador training. A short paragraph about these psychological difficulties that young cancer survivors are confronted with. 
Implementation: Targeted Theoretical material around these concepts that aim to familiarize the reader and normalize his/her experience:  
- Worksheets: 
A. Cognitive restructuring
B. Mindfulness exercises 
For example: 
A. Cognitive Restructuring
- A. «Stopping negative thoughts»: A document outlining a five-step method for handling cognitive distortions based on Cognitive Behavioral Therapy (CBT). These distorted thoughts, which can be intense and recurring, can negatively impact self-confidence, emotions, and social interactions, leading to anxiety and depression. That is why it is crucial to address and work through them (Getu et al., 2021; Mehta, Peynenburg, & Hadjistavropoulos, 2019; Murphy et al., 2019; Ye et al., 2018).  
  B. Mindfulness exercises
- Audio Mindfulness & Relaxation exercises: How to start with Meditation? : We have linked vidoes with a step by step guide in practicing meditation techniques in Greek and a video guiding the person involved. (Bower et al., 2021; Lathren et al., 2018).  These were created by a Greek yoga trainer.  

3. Identity issues: loss or changes in perceived identity, sexuality, body image (Lathren et al., 2018; Reinman et al., 2021). In this section you will find useful educational content about body image issues that may arise during your cancer journey as well as information about the impact of cancer on sexuality and fertility. Finally, this section will conclude with a LifeLine Exercise. 
1. Power point presentation for body image and changes during cancer as well as  a Power point presentation for sexuality.  
2. Therapeutic writing: e.g. “Lifeline” exercise (see Annex 2, p. 7).  

4. Self-help videos:
Short videos of young cancer survivors, sharing their experiences in relation to their cancer diagnosis. Young cancer survivors share how they experienced the disease and how they experience life after treatment. According to Krakow et al. (2017) using stories as a tool in health communication can be a valuable intervention. Narratives possess the potential to serve as an efficient strategy for public health communication, influencing behavior change (Chou et al., 2011; Lathren et al., 2018). We have filmed two videos: “The path of Konstantinos: Navigating Cancer’s Challenges” and “Resilience and reflection: the journey of Christina and her mother through cancer and beyond”.
Caregiver’s and health care professionals’ perspectives: Short videos with parents or caregivers of adolescent and young adult cancer survivors.  In addition, one video with one psychologist working with women diagnosed with breast cancer and one video with two oncology nurses. We have created one video in which two oncology nurses are discussing their work and what survivorship means for them under the title “Insights from Oncology nurses: A candid discussion”. The title for the second video is “Expert Perspectives: A Psychologist’s Insights into Supporting Oncology Patients”.

5. Podcasts from experts:
Episode 1: Q&A about life after therapy
Episode 2: Q&A about life after therapy II 
Episode 3: Psychological support in life after therapy
Episode 4: Diet in life after therapy
Episode 5: Training after therapy
Episode 6: Sexuality and Cancer
Episode 7: Questions On Education, Career Support & Work Integration in AYAs Cancer Survivors.

6. Other Supplementary Content for Adolescent and Young Adult Cancer Survivors 

1. Psychoeducation
Annex 1: Worksheet Example of Assertive Communication
Definition: “Assertiveness refers to the skill of communicating your desires, inquiries, and necessities in a precise and straightforward manner, which enables others, such as your healthcare providers, to comprehend your intentions. Utilizing assertiveness can enhance the quality of the care you receive”
Examples of Assertive communication (Approaches for exhibiting assertiveness while conversing with your medical professional)
- Employ "I" statements while communicating with your physician: for example: ‘‘I feel anxious, like I’m talking to a stranger, so I find it very hard to talk about anything in detail.’’ (Female;1, 24).
- In case of confusion, try reciting the information back to your physician. This technique, referred to as "mirroring," is often useful in clarifying any ambiguous aspects of the conversation. You can initiate it by saying, "So, if I understand correctly, you suggest that I..."

Annex 2: Example of “Fear of cancer recurrence’’
Here are some tips to help you feel more in control and less vulnerable:
• Accepting that what you’re feeling is a normal reaction: can help things feel more in control. Recognize and acknowledge your emotions - tell yourself that to be scared is natural, and that these feelings will lessen over time.
• Learn your triggers: you may soon recognize that future appointments set emotions spiraling.  Having a new pain, headache or symptom may make you feel panicky and anxious - remind yourself that many aches and pains are part of daily life, and doesn’t necessarily mean your cancer is back.
• The anniversary of events around your cancer and it’s treatment can be stressful too. Being aware of your triggers means you can prepare for the surge in emotions, and not be caught unawares.
• Plan ahead: ask your doctor or health care team what to look out for as signs that the cancer may be back. Find out who you should call if you have concerns, or symptoms you’re experiencing. Check out what the follow up process is, including any tests, scans and appointments.
• Think about ways to get through the build up to appointments, and how you might reward yourself after the stress of the day is over.
• Think about support: Talk to your family and friends about how their continued support is helpful, as when treatment finishes, you may still find things hard.
• Being part of a group, whether it’s online or face to face can help you feel less alone and realize that much of the anxiety you may be experiencing is similar to other people with cancer.
• Learn how to de-stress: this might be through exercise, meditation, mindfulness, hobbies, relaxation techniques and other therapies.
• Control the controllable: there are things you can do, to help keep yourself as well as you can. For example, attending your appointments, and checkups helps keep a regular eye on things. If a new symptom is troubling you, then tell your doctor.
• Eating healthily and building up your exercise can help keep your body well.
Source: Maggie’s (

4. Identity Issues
Annex 3: Experiential Exercise: “Life Line”
1. We would now like you to sit comfortably in your chair. I'm going to ask you now to close your eyes or look down and notice your breathing. Inhale..and exhale....(repeat 2-3 times) as you breathe, focus your attention on your shoulders notice if they are tense and let them relax, let them rest, ..... then observe your hands.. let them fall heavily without holding any weight…move to your pelvis and find the most comfortable position on your chair, let your pelvis relax and rest on it, move to your feet and let them fall heavily on the pelvis, and let them rest on the chair floor
2. We would now like you to make a line that shows your path until now. The line can have any shape and form you want, it will start from the beginning of life and will end in the present. In its shape will the most significant, in your opinion, incidents or periods of time in your life but also experiences, situations that you remember/ touched you. Think about your development to date, the setbacks/difficulties and also the beautiful and happy moments or circumstances.
3. Now draw the line you imagined. You can use different colors, materials, symbols, shapes, or short words to capture what came to your mind.
4. Notice your feeling right now and write it down on a paper next to you.
5. (Pause)
6. Now, we would like you to look back over your life line and think about the people, the positive relationships that have been close to you throughout this route. They may be people from the past who are no longer in your life or people dear to you who came and stayed to this day close to you, friends near or far, family close or extended, people who supported you and you knew them well or others that you knew well you knew less well or not at all, but somehow it was there for you.
7. Observe the memories as they come to your mind remember the faces, the names the sense of these people and note them up the line of your life.
8. Now notice how you feel.. Now notice your life line…
Reflection questions:
How is it now that your positive relationships have been imprinted and are the same with before? Has something changed? Keep the feeling you are having right now and write it down on the same piece of paper next to you. How easy was it for positive relationships to come to mind, where did everyone focus, how many also saw the toxic relationships next to the positive ones?

  1. Bower, J. E., Partridge, A. H., Wolff, A. C., Thorner, E. D., Irwin, M. R., Joffe, H., Petersen, L., Crespi, C. M., & Ganz, P. A. (2021). Targeting Depressive Symptoms in Younger Breast Cancer Survivors: The Pathways to Wellness Randomized Controlled Trial of Mindfulness Meditation and Survivorship Education. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 39(31), 3473–3484.
  2. Chou, W. Y., Hunt, Y., Folkers, A., & Augustson, E. (2011). Cancer survivorship in the age of YouTube and social media: a narrative analysis. Journal of medical Internet research, 13(1), e7.
  3. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.
  4. Getu, M. A., Chen, C., Wang, P., Yohannes, E., Seife, E., & Panpan, C. (2021). Study Protocol of CBT-AP Trial: A Randomized Controlled Trial of Cognitive Behavioral Therapy Integrated with Activity Pacing for Fatigued Breast Cancer Patients Undergoing Chemotherapy. Integrative cancer therapies, 20, 15347354211032268. 
  5. Grace, J. G., Schweers, L., Anazodo, A., & Freyer, D. R. (2019). Evaluating and providing quality health information for adolescents and young adults with cancer. Pediatric blood & cancer, 66(10), e27931.
  6. Jans-Beken, L., Jacobs, N., Janssens, M., Peeters, S., Reijnders, J., Lechner, L., & Lataster, J. (2020). Gratitude and health: An updated review. The Journal of Positive Psychology, 15(6), 743-782.
  7. Krakow, M., Yale, R. N., Perez Torres, D., Christy, K., & Jensen, J. D. (2017). Death narratives and cervical cancer: Impact of character death on narrative processing and HPV vaccination. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 36(12), 1173–1180.
  8. Lathren, C., Bluth, K., Campo, R., Tan, W., & Futch, W. (2018). Young adult cancer survivors’ experiences with a mindful self-compassion (MSC) video-chat intervention: A qualitative analysis. Self and Identity, 17(6), 646–665. doi:10.1080/15298868.2018.1451363.
  9. Lin, M., Sansom-Daly, U. M., Wakefield, C. E., McGill, B. C., & Cohn, R. J. (2017). Health Literacy in Adolescents and Young Adults: Perspectives from Australian Cancer Survivors. Journal of Adolescent and Young Adult Oncology, 6(1), 150–158. doi:10.1089/jayao.2016.0024.
  10. Mehta, S., Peynenburg, V. A., & Hadjistavropoulos, H. D. (2019). Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. Journal of Behavioral Medicine, 42(2), 169–187.
  11. Merckaert, I., Waroquier, P., Caillier, M., Verkaeren, O., Righes, S., Liénard, A., Libert, Y., Kristanto, P., & Razavi, D. (2023). Improving emotion regulation in breast cancer patients in the early survivorship period: Efficacy of a brief ecologically boosted group intervention. Psycho-oncology, 32(4), 597–609.
  12. Murno, F. (2016). Love, Light and Mermaid Tails: One Woman's Healing Journey Back to Wholeness Through Stage Four Cancer. CreateSpace Independent Publishing Platform.
  13. Murphy, M. J., Newby, J. M., Butow, P., Loughnan, S. A., Joubert, A. E., Kirsten, L., … Andrews, G. (2019). Randomised controlled trial of internet-delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT Early). Psycho-Oncology, 29(1), 76–85.
  14. Otto, A. K., Szczesny, E. C., Soriano, E. C., Laurenceau, J.-P., & Siegel, S. D. (2016). Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors. Health Psychology, 35(12), 1320–1328. doi:10.1037/hea0000400.
  15. PDQ® Supportive and Palliative Care Editorial Board. PDQ Communication in Cancer Care. Bethesda, MD: National Cancer Institute. Updated <01/02/2023>. Available at: Accessed <04/25/2023>. [PMID: 26389345].
  16. Razavi D, Delvaux N, Farvacques C, Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry. 1990;156(1):79-83.
  17. Reinman, L., Coons, H. L., Sopfe, J., & Casey, R. (2021). Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors. Children, 8(11), 1058.
  18. Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9(3):481-491.
  19. Thompson, M., & Gauntlett-Gilbert, J. (2008). Mindfulness with children and adolescents: Effective clinical application. Clinical child psychology and psychiatry, 13(3), 395-407. 
  20. Ye, M., Du, K., Zhou, J., Zhou, Q., Shou, M., Hu, B., … Liu, Z. (2018). A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psycho-Oncology,1–9.

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them.